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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. ADJ7626422
Regular
Dec 03, 2014

JOSE AHUMADA vs. BUILDING MATERIALS HOLDING, ACE AMERICAN INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) dismissed the defendant's petition for reconsideration because it sought review of an interlocutory order, not a final decision. However, the WCAB granted removal on its own motion to address the WCJ's order. This order, which directed the parties to obtain a new Qualified Medical Evaluator (PQME), was rescinded because the issue was moot after the defendant canceled the deposition and the PQME became available within the statutory timeframe. The WCAB cautioned the defendant for seeking reconsideration of a non-final procedural order.

PQMEPetition for ReconsiderationWCJ Orderdepositionreplacement PQMEinterlocutory orderremovalrescindedmoot issuevocational expert
References
Case No. ADJ7674144
Regular
Oct 21, 2015

CHERYL FRANK vs. NOVATO UNIFIED SCHOOL DISTRICT, YORK RISK SERVICES GROUP

The Workers' Compensation Appeals Board (WCAB) affirmed a prior decision finding that most alleged industrial stressors leading to the applicant's psyche injury claim were not barred by Labor Code section 3208.3(d). The WCAB upheld the administrative law judge's (WCJ) determination that the panel Qualified Medical Evaluator's (PQME) reports lacked substantial evidence and removed the PQME. The WCAB dismissed the defendant's petition for removal, finding reconsideration to be the appropriate remedy and giving significant weight to the WCJ's credibility determinations.

Workers' Compensation Appeals Boardpsychiatric injuryindustrial stressorLabor Code section 3208.3(d)removalQualified Medical EvaluatorPQMEsubstantial evidencecredibility determinationsPetition for Reconsideration
References
Case No. ADJ8898297
Regular
Mar 27, 2015

MARY ROBY-LEWIS vs. COUNTY OF SACRAMENTO

This case involves the County of Sacramento's attempt to overturn an order striking their chosen Qualified Medical Examiner (PQME) and a consulting physician. The defendant argued this order caused irreparable harm and that the applicant waived objections by delaying their request. The Appeals Board dismissed the reconsideration petition as untimely because the order wasn't final, but granted removal and rescinded the WCJ's order. The majority found the applicant's objections lacked merit and that denying removal would cause prejudice, while a dissenting opinion argued the defendant failed to comply with procedural rules regarding document submission to the PQME.

PQMEPetition for ReconsiderationPetition for RemovalOrder Striking PQMELabor Code Section 4062.3(b)Panel Qualified Medical ExaminerWCJ OrderApplicantDefendantSubstantial Prejudice
References
Case No. ADJ13119496
Regular
Sep 29, 2025

Ariel Prudente vs. RJP Framing, Inc., Alaska National Insurance Company

Applicant Ariel Prudente sought removal of a WCJ's order to replace psychiatric Qualified Medical Evaluator (PQME) Dr. Peter Turek. The WCJ's decision stemmed from applicant's attorney providing "summaries and excerpts from the Kite decisions" to Dr. Turek, which was deemed a violation of Labor Code section 4062.3(b). The Appeals Board found that the WCJ's order lacked sufficient rationale and evidence of prejudice to justify Dr. Turek's replacement. Consequently, the Board granted the petition for removal, rescinded the WCJ's June 18, 2025 Findings and Order, and remanded the matter for further proceedings, emphasizing the need for less drastic measures than QME replacement.

PQMEPetition for RemovalLabor Code section 4062.3(b)Kite decisionsVigil v. County of KernSuon v. California DairiesMaxham v. California Department of Corrections and Rehabilitationex parte communicationsubstantial justiceAOE/COE
References
Case No. ADJ9795000
Regular
Sep 15, 2015

JACQUITA HUNTLEY vs. A.H. 2005 MANAGEMENT, PENNSYLVANIA MANUFACTURERS ASSOCIATION INSURANCE COMPANY

The applicant sought removal of a WCJ's finding that the defendant's request for a Qualified Medical Examiner (PQME) was valid. Applicant argued her prior PQME request and the defendant's failure to attach proper documentation invalidated their request. The Board denied the removal petition, adopting the WCJ's report which noted the applicant stipulated to the invalidity of her own PQME request. Furthermore, the Board admonished applicant's attorneys for making false statements and potentially violating Labor Code section 5813.

Petition for RemovalQualified Medical Examiner (PQME)Labor Code section 4061Rule 31.1StipulationTreating PhysicianOrthopedic Surgical PanelChiropractic PQMEBad Faith ActionsFrivolous Tactics
References
Case No. ADJ7253987
Regular
Jun 29, 2012

Anna Medel vs. Employment Development Department, State Compensation Insurance Fund

The defendant sought reconsideration of an order granting the applicant a new Qualified Medical Evaluator (PQME). The defendant argued their communication with the PQME was not an ex parte violation and that the objection was untimely. The Board dismissed the reconsideration petition, finding the order was procedural, not final. The Board denied the removal petition, agreeing that the defendant's communication violated Labor Code Section 4062.3 by failing to serve the applicant 20 days prior to the PQME evaluation. Therefore, the applicant was correctly awarded a new PQME panel.

Workers' Compensation Appeals BoardPanel Qualified Medical EvaluatorPQMESection 4062.3Ex Parte CommunicationReconsiderationRemovalCumulative Trauma InjuryCervical SpineBilateral Upper Extremities
References
Case No. ADJ9638094
Regular
Apr 04, 2016

ALEJANDRO GONZALEZ CEJA vs. TREASURY WINE ESTATES, SENTRY INSURANCE CO.

The Workers' Compensation Appeals Board granted reconsideration, rescinded findings on permanent disability, and returned the case for further proceedings. The Board found the Qualified Medical Evaluator's (PQME) apportionment of 25% permanent disability to pre-existing arthritis lacked substantial evidence. Specifically, the PQME failed to adequately explain the basis and causation for this apportionment, particularly when also stating the job duties likely aggravated and accelerated the condition. The matter was returned to clarify the PQME's apportionment determination before a new decision is issued.

ApportionmentPQMECumulative traumaVineyard workerLeft shoulderLeft elbowPermanent disabilitySubstantial evidencePre-existing conditionAcromioclavicular joint arthritis
References
Case No. ADJ1088185 (SAC 0369416)
Regular
May 25, 2012

DEBORAH COIL vs. CITY OF RANCHO CORDOVA

The Workers' Compensation Appeals Board (WCAB) dismissed Deborah Coil's petition for reconsideration because the WCJ's order was procedural, not a final determination of substantive rights. The WCAB reasoned that Coil's contentions about the PQME's familiarity with the AMA Guides were misplaced as those guides are not relevant to psychiatric impairment ratings. Therefore, the WCAB denied removal and dismissed the petition, allowing the PQME another opportunity to re-evaluate the applicant without her husband present. A concurring and dissenting opinion argued for removal, citing the PQME's repeated inability to produce substantial medical evidence.

Panel Qualified Medical EvaluatorPQMEPetition for ReconsiderationRemovalLabor Code Section 5900Labor Code Section 5310Final OrderSubstantial Medical EvidenceAMA GuidesAlmaraz/Guzman
References
Case No. ADJ8189240
Regular
Mar 04, 2013

MARY VAN RYN vs. BEJO SEEDS, INC., INSURANCE COMPANY OF THE WEST/EXPLORER INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and rescinded a prior award, finding the medical evidence insufficient. The WCAB determined that the Panel Qualified Medical Evaluator's (PQME) opinion, which formed the basis of the award for industrial injury, lacked substantial evidence. Specifically, the PQME's supplemental report was based on inadequate history and examination, failing to consider crucial factors like job activities and non-work history. The case is returned to the trial level for further development of the record, including potential re-evaluation by the PQME with a job analysis or examination by a regular physician.

WCABReconsiderationFindings and AwardPQMESubstantial EvidenceIndustrial InjuryCumulative TraumaMedical OpinionLabor Code Section 5701EDD Lien
References
Case No. ADJ8606940
Regular
Apr 18, 2013

ANGELICA PEREZ vs. PERMANENTE MEDICAL GROUP, INC.

The Workers' Compensation Appeals Board denied defendant's petition for removal or reconsideration regarding the applicant's entitlement to multiple Panel Qualified Medical Examiners (PQMEs). The defendant contested the procedural validity of the applicant's PQME requests, while the applicant asserted proper procedure was followed due to the defendant's lack of response to an Agreed Medical Examiner offer. The Board found that the February 4, 2013 notation was not a final order, as PQME requests remained pending with the Medical Unit. Therefore, the petition was denied without prejudice to the Medical Unit's future determination on the propriety of the PQME requests.

Panel Qualified Medical ExaminersPQMEPetition for RemovalPetition for ReconsiderationIndustrial InjuryCumulative InjuryAgreed Medical ExaminerAMEMedical UnitAdministrative Law Judge
References
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